World Allergy Organization Sublingual Immunotherapy Position Paper: 2026 update
42
Issued Date
2026-10-01
Resource Type
eISSN
19394551
Scopus ID
2-s2.0-105051506173
Journal Title
World Allergy Organization Journal
Volume
19
Issue
10
Rights Holder(s)
SCOPUS
Bibliographic Citation
World Allergy Organization Journal Vol.19 No.10 (2026)
Suggested Citation
Canonica G.W., Morais-Almeida M., Di Bona D., Ansotegui I.J., Oppenheimer J.J., Al-Nesf M., Bernstein J.A., Caimmi D., Chang Y.S., Davis C.M., Ebisawa M., Fiocchi A., Gómez R.M., González-Díaz S.N., Hong S.J., Papadopoulos N.G., Pawankar R., Peter J.G., Rojo Gutiérrez M.I., Tantilipikorn P., Virchow J.C., Wong G.W.K., Zachary C.Y., Fernandez-Caldas E., Durham S.R., Alangari A.A., Ishchanka A., Latiff A.H.A., Jang A.S., Morete A., Bożek A., Nowak-Wegrzyn A.H., Ellis A.K., Irani C., Panaitescu C.B., Rondón C., Zubrinich C., Betancourt Sánchez D., González-Mancebo E., Hidalgo Castro E.M., Ng'ang'a E., Zaitoun F.H., Rodrigues Fernandes F., Andoh H.D., Chantaphakul H., Kaidashev I., Nasr I., Chong-Neto H., Pereira C., Dorsainvil J.C., Tracy J.M., Li J., Trujillo J., Jamalyan K.R., Gáspár K., Ahmetaj L., Worm M., Staevska M., Atanasković-Marković M., Bukovskis M., Valentin Rostan M., Gharnaout M., Gotoh M., Al-Ahmad M., Sonomjamts M., Prasad K.N., Odusote O., Monge Ortega O.P., Tsilochristou O., Demoly P., Stepaniuk P., Panzner P., Li P.H., Aguilera-Insunza R., Sepiashvili R., Asero R., Tarazona Martinez R.A., Altrichter S., Husain S., Karabus S.J., Uriarte S.A., de Barayazarra S., Huq S.R., Abbas S.S., Zuberbier T., Sahiner U.M., Pereira V.A.R., Patella V., Kvedarienė V., Tal Y., Ispayev Z., Martin B.L. World Allergy Organization Sublingual Immunotherapy Position Paper: 2026 update. World Allergy Organization Journal Vol.19 No.10 (2026). doi:10.1016/j.waojou.2026.101442 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/119337
Title
World Allergy Organization Sublingual Immunotherapy Position Paper: 2026 update
Author(s)
Canonica G.W.
Morais-Almeida M.
Di Bona D.
Ansotegui I.J.
Oppenheimer J.J.
Al-Nesf M.
Bernstein J.A.
Caimmi D.
Chang Y.S.
Davis C.M.
Ebisawa M.
Fiocchi A.
Gómez R.M.
González-Díaz S.N.
Hong S.J.
Papadopoulos N.G.
Pawankar R.
Peter J.G.
Rojo Gutiérrez M.I.
Tantilipikorn P.
Virchow J.C.
Wong G.W.K.
Zachary C.Y.
Fernandez-Caldas E.
Durham S.R.
Alangari A.A.
Ishchanka A.
Latiff A.H.A.
Jang A.S.
Morete A.
Bożek A.
Nowak-Wegrzyn A.H.
Ellis A.K.
Irani C.
Panaitescu C.B.
Rondón C.
Zubrinich C.
Betancourt Sánchez D.
González-Mancebo E.
Hidalgo Castro E.M.
Ng'ang'a E.
Zaitoun F.H.
Rodrigues Fernandes F.
Andoh H.D.
Chantaphakul H.
Kaidashev I.
Nasr I.
Chong-Neto H.
Pereira C.
Dorsainvil J.C.
Tracy J.M.
Li J.
Trujillo J.
Jamalyan K.R.
Gáspár K.
Ahmetaj L.
Worm M.
Staevska M.
Atanasković-Marković M.
Bukovskis M.
Valentin Rostan M.
Gharnaout M.
Gotoh M.
Al-Ahmad M.
Sonomjamts M.
Prasad K.N.
Odusote O.
Monge Ortega O.P.
Tsilochristou O.
Demoly P.
Stepaniuk P.
Panzner P.
Li P.H.
Aguilera-Insunza R.
Sepiashvili R.
Asero R.
Tarazona Martinez R.A.
Altrichter S.
Husain S.
Karabus S.J.
Uriarte S.A.
de Barayazarra S.
Huq S.R.
Abbas S.S.
Zuberbier T.
Sahiner U.M.
Pereira V.A.R.
Patella V.
Kvedarienė V.
Tal Y.
Ispayev Z.
Martin B.L.
Morais-Almeida M.
Di Bona D.
Ansotegui I.J.
Oppenheimer J.J.
Al-Nesf M.
Bernstein J.A.
Caimmi D.
Chang Y.S.
Davis C.M.
Ebisawa M.
Fiocchi A.
Gómez R.M.
González-Díaz S.N.
Hong S.J.
Papadopoulos N.G.
Pawankar R.
Peter J.G.
Rojo Gutiérrez M.I.
Tantilipikorn P.
Virchow J.C.
Wong G.W.K.
Zachary C.Y.
Fernandez-Caldas E.
Durham S.R.
Alangari A.A.
Ishchanka A.
Latiff A.H.A.
Jang A.S.
Morete A.
Bożek A.
Nowak-Wegrzyn A.H.
Ellis A.K.
Irani C.
Panaitescu C.B.
Rondón C.
Zubrinich C.
Betancourt Sánchez D.
González-Mancebo E.
Hidalgo Castro E.M.
Ng'ang'a E.
Zaitoun F.H.
Rodrigues Fernandes F.
Andoh H.D.
Chantaphakul H.
Kaidashev I.
Nasr I.
Chong-Neto H.
Pereira C.
Dorsainvil J.C.
Tracy J.M.
Li J.
Trujillo J.
Jamalyan K.R.
Gáspár K.
Ahmetaj L.
Worm M.
Staevska M.
Atanasković-Marković M.
Bukovskis M.
Valentin Rostan M.
Gharnaout M.
Gotoh M.
Al-Ahmad M.
Sonomjamts M.
Prasad K.N.
Odusote O.
Monge Ortega O.P.
Tsilochristou O.
Demoly P.
Stepaniuk P.
Panzner P.
Li P.H.
Aguilera-Insunza R.
Sepiashvili R.
Asero R.
Tarazona Martinez R.A.
Altrichter S.
Husain S.
Karabus S.J.
Uriarte S.A.
de Barayazarra S.
Huq S.R.
Abbas S.S.
Zuberbier T.
Sahiner U.M.
Pereira V.A.R.
Patella V.
Kvedarienė V.
Tal Y.
Ispayev Z.
Martin B.L.
Author's Affiliation
The University of British Columbia
The Ohio State University
The University of Manchester
Università degli Studi di Napoli Federico II
The University of Hong Kong
Charles University
Charité – Universitätsmedizin Berlin
Chinese University of Hong Kong
Université de Montpellier
National and Kapodistrian University of Athens
University of Cape Town
NYU Grossman School of Medicine
University of South Florida, Tampa
Universiti Kebangsaan Malaysia
Hacettepe Üniversitesi
University of Cincinnati College of Medicine
Universidade Federal do Parana
University College Cork
Universität Rostock
Universidad de Málaga
University of Ulsan College of Medicine
Debreceni Egyetem
Vilniaus Universitetas
Rutgers Health
Guy's and St Thomas' NHS Foundation Trust
Slaski Uniwersytet Medyczny w Katowicach
College of Medicine
Kuwait University
National Heart and Lung Institute
Seoul National University Bundang Hospital
Nippon Medical School
Centre Hospitalier Universitaire de Montpellier
Humanitas Research Hospital
Latvijas Universitāte
Universidad Autónoma de Nuevo León
IRCCS Ospedale Pediatrico Bambino Gesù
Siriraj Hospital
Università degli Studi di Foggia
Faculty of Medicine
Humanitas University
College of Medicine
Hamad Medical Corporation
Universitatea de Medicina si Farmacie Victor Babes din Timisoara
The First Affiliated Hospital of Guangzhou Medical University
Faculty of Medicine, Chulalongkorn University
Howard University College of Medicine
Cork University Hospital
Clinica Alemana
Kepler Universitätsklinikum
University Hospital Alexandrovska
Queen's University, School of Medicine
Universidade de Coimbra, Faculdade de Farmácia
Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina
Red Cross War Memorial Children's Hospital
Hôtel-Dieu de France Hospital
Hospital Universitario de Fuenlabrada
National Hospital Organization Sagamihara National Hospital
Asfendiyarov Kazakh National Medical University
Hospital do Servidor Publico Estadual
Royal Hospital
Poltava State Medical University
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP
University Children's Hospital, Belgrade
Mongolian National University of Medical Sciences
Lagos State University Teaching Hospital
Dhaka Medical College and Hospital
Vitebsk State Medical University
Medizinische Fakultät
Alfred Health
Hospital Nacional de Clínicas
Universidad Catolica de Salta
Pantai Holdings Sdn Bhd
Centre Hospitalier et Universitaire de Béni-Messous, Algiers
British Hospital Montevideo
Instituto PENSI
Hospital Infante D. Pedro EPE
Greater Accra Regional Hospital
Clínica Delgado
Hospital CUF Descobertas
Hospital Quironsalud Bizkaia
Clemenceau Medical Center Hospital
Clinica San Carlo
Allergy and Asthma Institute
Erebuni Medical Center
Santa Maria della Speranza Hospital
Alcalá de Henares
Mexico City
Agency of Health ASL
Pius Brinzeu County Clinical Emergency Hospital
Hospital CIMA
HRB Clinical Research Facility Cork (CRF-C)
Bengaluru Allergy Centre
Universidad de Mexico
Georgian National Academy of Sciences
Midwest Allergy and Asthma
Medical Faculty
Queensland University
Paediatric Allergy Center
Soonchunhuyang University College of Medicine
Advance Medical Center
Inmunocenter LAB
The Ohio State University
The University of Manchester
Università degli Studi di Napoli Federico II
The University of Hong Kong
Charles University
Charité – Universitätsmedizin Berlin
Chinese University of Hong Kong
Université de Montpellier
National and Kapodistrian University of Athens
University of Cape Town
NYU Grossman School of Medicine
University of South Florida, Tampa
Universiti Kebangsaan Malaysia
Hacettepe Üniversitesi
University of Cincinnati College of Medicine
Universidade Federal do Parana
University College Cork
Universität Rostock
Universidad de Málaga
University of Ulsan College of Medicine
Debreceni Egyetem
Vilniaus Universitetas
Rutgers Health
Guy's and St Thomas' NHS Foundation Trust
Slaski Uniwersytet Medyczny w Katowicach
College of Medicine
Kuwait University
National Heart and Lung Institute
Seoul National University Bundang Hospital
Nippon Medical School
Centre Hospitalier Universitaire de Montpellier
Humanitas Research Hospital
Latvijas Universitāte
Universidad Autónoma de Nuevo León
IRCCS Ospedale Pediatrico Bambino Gesù
Siriraj Hospital
Università degli Studi di Foggia
Faculty of Medicine
Humanitas University
College of Medicine
Hamad Medical Corporation
Universitatea de Medicina si Farmacie Victor Babes din Timisoara
The First Affiliated Hospital of Guangzhou Medical University
Faculty of Medicine, Chulalongkorn University
Howard University College of Medicine
Cork University Hospital
Clinica Alemana
Kepler Universitätsklinikum
University Hospital Alexandrovska
Queen's University, School of Medicine
Universidade de Coimbra, Faculdade de Farmácia
Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina
Red Cross War Memorial Children's Hospital
Hôtel-Dieu de France Hospital
Hospital Universitario de Fuenlabrada
National Hospital Organization Sagamihara National Hospital
Asfendiyarov Kazakh National Medical University
Hospital do Servidor Publico Estadual
Royal Hospital
Poltava State Medical University
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP
University Children's Hospital, Belgrade
Mongolian National University of Medical Sciences
Lagos State University Teaching Hospital
Dhaka Medical College and Hospital
Vitebsk State Medical University
Medizinische Fakultät
Alfred Health
Hospital Nacional de Clínicas
Universidad Catolica de Salta
Pantai Holdings Sdn Bhd
Centre Hospitalier et Universitaire de Béni-Messous, Algiers
British Hospital Montevideo
Instituto PENSI
Hospital Infante D. Pedro EPE
Greater Accra Regional Hospital
Clínica Delgado
Hospital CUF Descobertas
Hospital Quironsalud Bizkaia
Clemenceau Medical Center Hospital
Clinica San Carlo
Allergy and Asthma Institute
Erebuni Medical Center
Santa Maria della Speranza Hospital
Alcalá de Henares
Mexico City
Agency of Health ASL
Pius Brinzeu County Clinical Emergency Hospital
Hospital CIMA
HRB Clinical Research Facility Cork (CRF-C)
Bengaluru Allergy Centre
Universidad de Mexico
Georgian National Academy of Sciences
Midwest Allergy and Asthma
Medical Faculty
Queensland University
Paediatric Allergy Center
Soonchunhuyang University College of Medicine
Advance Medical Center
Inmunocenter LAB
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Sublingual immunotherapy (SLIT) is a well-established form of allergen immunotherapy with demonstrated efficacy and a favorable safety profile in IgE-mediated allergic diseases, particularly in allergic rhinitis and allergic asthma. Since the publication of previous World Allergy Organization (WAO) position papers, accumulating evidence and expanding global clinical experience has justified an updated, internationally harmonized framework to guide the appropriate use of SLIT across diverse healthcare settings. Methods An international panel of experts developed an updated Position Paper on SLIT using a structured Delphi consensus methodology. Statements were formulated based on a targeted review of the scientific literature and expert clinical experience, addressing indications, patient selection, safety, treatment duration, adherence, biomarkers, disease modification, and implementation domains. Two rounds of anonymous electronic voting were conducted. Consensus was predefined as ≥70% agreement (scores 4–5 on a 5-point Likert scale). Results Eighty-three experts representing all WAO regions were invited, and seventy-eight of them participated in the Delphi process. High levels of consensus were achieved for core principles, including SLIT effectiveness, safety, the importance of appropriate patient selection, a minimum treatment duration of 3 years, supervised administration of the first dose followed by home-based treatment, and the central role of adherence and regular follow-up. Consensus regarding disease-modifying effects was stronger for children and adolescents than for adults. Lower consensus was observed on topics related to regional allergens, likely influenced by differences in allergen exposure, product availability, clinical experience, and regulatory contexts; however, formal region-stratified analyses were not performed. Conclusions This WAO Position Paper establishes a globally applicable, evidence-informed consensus framework for the positioning and implementation of SLIT. By clearly delineating areas of strong agreement and domains of conditional or context-dependent evidence, it provides both a clinical reference and a strategic roadmap for equitable and sustainable SLIT integration worldwide.